经皮椎体成形术中骨水泥填充对患者凝血功能的影响

Effects of bone cement on coagulation functions during percutaneous vertebroplasty in patients with osteoporotic spinal compression fractures

目的:探讨经皮椎体成形术中骨水泥对骨质疏松性椎体压缩骨折患者凝血功能的影响及临床意义。方法:2006年12月至2007年12月,对24例骨质疏松性椎体压缩骨折患者行经皮椎体成形术,男6例,女18例;年龄48～83岁,平均69岁。脊柱骨折部位为T5～L3,共44个椎体,其中胸椎20个椎体,腰椎24个椎体。采用C型臂X线机透视引导下行经皮椎体成形术,注射聚甲基丙烯酸甲酯骨水泥(PMMA)。分别在注入骨水泥前10min、注入骨水泥后10min、30min、1h、2h及3h时检测患者凝血功能相关指标,包括血浆凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、鱼精蛋白副凝固试验(3P试验)及血浆D-二聚体(D-D)含量,并进行统计学分析。结果:经皮椎体成形术中注入骨水泥10min后PT缩短、FIB增高、3P试验阳性率升高,D-D含量增高,1h时达到高峰后开始下降。注入骨水泥后10min、30min、1h、2h四个时间点与注入骨水泥前相比较均有显著性差异(P<0.05)。活化的部分凝血活酶时间(APTT)、凝血酶时间(TT)在各时间点与注入骨水泥前比较均无显著性差异(P>0.05)。3h后骨水泥对这些指标的影响基本消除,各项指标与注入骨水泥前比较均无显著性差异(P>0.05)。结论:经皮椎体成形术中骨水泥填充会引起患者一过性血液高凝状态,在注入骨水泥后的3h内需严密监测病情,以防血栓性疾病发生。

Objective：To evaluate the curative effect and clinical significance of bone cement on coagulation functions during percutaneous vertebroplasty （PVP） in patients with osteoporotic spinal compression fractures. Method：Twenty-four patients （18 females and 6 males） with 44 vertebral compression fractures underwent PVP between December 2006 and the same month 2007 involved in this study.They were average 69 years of age（48-83 years）.The fracture segment was within T5-L3（20 thoracical vertebrae,24 lumbar vertebrae ）.Under the guidance of C-arm fluoroscopy,bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae.Polymethylmethacrylate（PMMA） was then injected into the fractured vertebrae. The relative parameters were observed in all patients,including prothrombin time （PT）,activated partial throm- boplastin time（APTT）,thrombin time（TF）,fibrinogen（FIB）,plasma protamine paracoagulation test（3P test）,and D-dipolymer （D-D）.Blood samples were measured 10min before,10min,30min,1h,2h and 3h after bone cement implantation.Result：PT,FIB,3P test,D-D were changed after bone cement implantation in PVP.There were significant difference between bone cement preimplantation and 10min,30min,lh,2h after bone cement implantation in above-mentioned four parameters（P〈0.05）,and no difference in AFTT,TT parameters（P〉0.05）. The influence was vanished in 3h after bone cement implantation.Conclusion：Bone cement implantation cause temporal hypercoagulabale state in percutaneous vertebroplasty.In case thromb disease,it is important to monitor blood clotting state after bone cement implantation.